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iStent as a Solo Procedure for Glaucoma Patients: A Systematic Review and Meta-Analysis
Monali S Malvankar-Mehta1, Yufeng Nancy Chen2, Yiannis Iordanous3
1Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Minimally invasive glaucoma surgery (MIGS) using the iStent device effectively lowers intraocular pressure (IOP) and reduces the need for glaucoma medications. This solo procedure demonstrates sustained IOP reduction and medication decrease for at least 18 months.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Management
Background:
- Glaucoma is a primary cause of irreversible blindness, traditionally managed with pharmacotherapy.
- Pharmacotherapy for glaucoma presents significant challenges and limitations.
- Minimally invasive glaucoma surgery (MIGS) targeting the outflow pathway offers a new paradigm in glaucoma treatment.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of the iStent MIGS device.
- To quantify the impact of iStent implantation as a solo procedure on intraocular pressure (IOP).
- To assess the effect of iStent implantation on the number of topical glaucoma medications used post-operatively.
Main Methods:
- Systematic review of studies published between 2000 and 2014.
- Inclusion of studies with up to 24 months follow-up.
- Meta-analysis using STATA v. 13.0 to calculate standardized mean difference (SMD) for IOP and medication reduction.
Main Results:
- iStent implantation led to significant IOP reduction, with greater reduction observed with more implants (up to 40% with three iStents).
- A mean reduction of 1 to 1.45 bottles of topical glaucoma medications per patient was observed.
- Significant IOP reduction persisted up to 12 months, and medication reduction was noted up to 18 months post-implantation.
Conclusions:
- iStent implantation as a standalone procedure effectively lowers IOP.
- The procedure reduces patient reliance on topical glaucoma medications.
- The IOP-lowering and medication-sparing effects of iStent implantation are sustained for at least 18 months.
